Damage to the pudendal nerve can occur suddenly as a result of trauma to the pelvic region, prolonged bicycling, fractures, or from falls. The pudendal nerve re-enters the pelvis under the sacrotuberous ligament and gives three branches.
The first branch, the inferior rectal nerve, provides rectal tone and perianal sensation. The second branch, the Perineal Nerve, gives scrotal sensation. The third branch, the dorsal nerve of the penis, give branches to the corpus callosum.
The pudendal nerve arises from S2, S3, and S4. The pudendal nerve carries sensations to the external genitals, the lower rectum, and the perineum.
The symptoms of pudendal nerve palsy can start suddenly or develop over time. Symptoms include the loss of sensation or numbness, burning or stabbing pain, difficulty with bladder and bowel functions, and sexual dysfunction.
Causes of pudendal nerve palsy include prolonged sitting exercises such as bicycling or following fracture table traction—the nerve is compressed between the ischium and the hard object.
Treatment options are typically conservative, as the condition is usually transient and will improve over time. Treatment includes:
- Physical therapy
- Stretches and exercises
- Anti-inflammatory medications
- Injections/nerve blocks
- Surgery (as a last resort)
Prevention options for bicyclists consists of changing the sitting position while riding the bicycle and changing the seat from a narrow seat to a wider seat.